Impact and Cost of Long-Term Care on the Family

¶ … Long-Term Care on the Family

Social Factors Affecting Care Giving

Effects of Divorce

Effects of Abuse and Neglect

Effects of Women in the Workforce

Proximity and Other Factors

The Long-term Care Shortage

Factor Involved

Future Trends

Formal Long-term Care: The Impact on Society

Minority Issues

Financial Impact on Family

Social Workers and Home Caregivers

The Effects on the Caregiver

Physical and Emotional Symptoms

Five Major Causes of Stress Among Home Caregivers

Wearing Many Hats

The Impact and Cost of Long-term Care on the Family

Long-term care can be needed for a variety of reasons from accident injuries, debilitating and long-term illness, or simply due to becoming elderly. There are sometimes when persons cannot care for themselves and must rely on others for their daily needs. Sometimes the care takes place in a facility designed to provide such services. However, sometimes the burden of caring for loved ones falls on family members or even friends. Long-term care places a strain on people financially. This has been the primary focus of health care policy regarding long-term care in the past. However, there is an often-overlooked aspect of long-term care.

Long-term care has many emotional issues associated with it as well, not only for the patient, but for the caregiver as well. These issues can cause a variety of difficulties including depression, fatigue, stress and can even lead to the break up of a family. These issues place an even greater burden on the system and society as a whole. These issues must be considered when making new long-term health care policies. These issues will be the focus of the following research.

The problems associated with long-term health care of the elderly and sick have many facets. Long-term health care in facilities, such as nursing homes is expensive. The United States is facing a growing shortage of health care workers to care for the elderly and this trend is expected to worsen. In many cases families choose to care for the person at home rather than incur potentially devastating costs. When family care is not an option and the family does not have the resources to pay, the government must foot the bill. Caring for a patient at home is expensive as well, and often places an incredible financial strain on the family. The following research will explore these issues from many angles and will discuss potential solutions.

Social Factors Affecting Care Giving

There was a time when long-term care facilities did not exist and the entire burden of caring for the elderly or sick was always placed on the family. There are many who feel that this the way it still is and should be, However, the family structures are changing and this concept has now been shown to be a myth (Montgomery, 1999). This shifting family structure means that an increasing number of elderly persons are relying on long-term care facilities to replace the traditional family role. The following will explore some of the issues behind these trends.

Divorce rates have been climbing for many years and the traditional idea of the nuclear is quickly being re-defined. As a result, there are now more elderly people who are divorced. The effects of this trend can be shown in the long-term care that these elders are likely to receive from their children. Divorce can harm family ties and often creates feelings of resentment or rejection in many family members. According to a study conducted by Shone and Pezzin, (1999) divorce makes it less likely that families will help each other financially or in terms of physical care. The key findings of this study were that adult children of divorced children were less likely to receive financial assistance from their parents. In addition, stepparents were less likely to receive care from their children than biological parents were. The study found that remarriage reduced the likelihood that an elderly person would receive care even further (Shone and Pezzin, 1999).

A history of abuse or neglect in the family may be a factor in whether elderly persons receive care from their children. Child abuse and neglect severs family ties and can have an impact on whether the person receives care in their elder years (CASA, 2001). This issue is often an overlooked effect of child abuse. Many consider the immediate social costs of child abuse. However, the willingness to care for the elderly is a long-term effect of childhood abuse and neglect. Current studies only focus the effects to the abused person themselves. They fail to consider the effects of the broken family ties later in life.

Studies have indicated that men and women neat retirement age, whose parents are still living, are spending less time caring for them or helping with daily tasks such as household chores (Johnson and Lo Sasso, 2000). Women are playing a greater role in the workforce and this may have an impact on these figures. Parental health was found to be a key predictor in determining whether the elderly person would receive assistance from their children (Johnson and Lo Sasso, 2000). Health was factor in determining whether children provided basic case, such as feeding or dressing, however, was not a factor in helping with daily chores and errands (Johnson and Lo Sasso, 2000).

Other factors that were determined to be a predictor of whether children helped to care for their parents were the vicinity in which they lived. Children who lived closer to their parents were more likely to provide help than those who lived far away (Johnson and Lo Sasso, 2000). When both parents were alive, the children were less likely to provide help, as the other surviving spouse was likely to provide care. In addition, children in their mid-life who had small children or problems within the immediate family, such as an ill spouse, did not decrease the likelihood that the adult child would provide help for the parent (Johnson and Lo Sasso, 2000).

The Long-term Care Worker Shortage

As the population grows increasingly more elderly, the United States is facing a shortage of worker to care for them (Weiner, et. al., 2000). According to Weiner and associates (2000) poor working conditions are partially to blame for he current crisis. Long-term care workers face low wages, poor benefits, heavy workloads, and poor working conditions and a lack of respect. This makes the profession subject to high turnover rate and difficulty in recruiting new workers. This problem is expected to get worse before it gets better.

Formal Long-term Care: The Impact on Society

The number of elderly receiving formalized long-term care, from a licensed long-term care facility is expected to double over the next 30 years (Johnson and Lo Sasso, 2000). Much of this long-term care will be funded with public funds, placing a growing financial burden on government budgets. Nursing home expenditures have increased from $17.4 billion in 1970 to $84.7 billion in 1997 (expressed in 1997 dollars) (Health Care Financing Administration, 1998).

Long-term care places a growing strain on society as a whole.

When a family decides to care for a loved one at home, many do not realize the costs involved. Some of these costs are financial and some are less easily measurable. The person providing the care must often balance working a paid job with providing the care. A 1996, study revealed that approximately 10.5% of all elderly patients that were being cared for at home were unable to perform basic tasks such as feeding themselves, getting out of bed, or dressing (Johnson and Lo Sasso, 2000). Adult children account for 42% of all caregivers for unmarried elderly persons receiving nonistitutional care (Johnson and Lo Sasso, 2000).

Results on Caregiving in foreign countries and among ethnic groups in the Untied States revealed different results than those conducted on mainstream populations. For instance in Japan, one study found that those caring for elderly persons who were totally disabled showed more signs of stress than those who were caring for partially disabled persons (Yumiko and Washio, 1999). It has been found that socio-cultural factors should be considered when evaluating Caregiving and caregivers in ethnic groups. Family structure was found to be a key issue in ethnic issues (Dilworth-Anderson and Gibson, 1999). Ho, et. al. (2000) found that minority caregivers to persons with dementia used fewer outside social and medical services than white, European-American caregivers. The study focused on and Latino caregivers and sites cultural and other factors as reasons for this. The same study found the minority caregivers often suffered from a higher level of stress than their European counterparts. Another study focused only on African-Americans and found similar results (Cox, 1999).

Caring for an elderly parent leaves less time for other activities, such as work. The more assistance the person needs, the greater the time spent caring for them. Activities such as meal preparation and transportation to doctor's visits can make it difficult to work regular hours on a job. It is difficult to measure the true effects of elderly care on the labor force in a meaningful way as many of he effects cannot be quantified easily (Johnson and Lo Sasso, 2000). Persons who must work fewer hours in order to care for a loved one lose more than the reduced income. They lose in terms of lost retirement savings, benefits and can lose healthcare benefits for themselves. This can place strain on the person giving the care in many ways.

Few public assistance programs exist to aid those who care for elderly patients. The Clinton administration enacted a tax credit of $3,000 for persons who care for persons needing assistance at home (Johnson and Lo Sasso, 2000). There are several emerging programs to provide respite and services to caregivers. The Omnibus long-term Care Act of 1999 (H.R. 2691) would provide Medicare benefits and Social Security credits to workers who leave their jobs to care for their frail parents (Johnson and Lo Sasso, 2000). These are just a few of the measures being taken to help alleviate burden and strain on caregivers. They are not enough in many cases, but they are a start.

Many feel that this is an area that needs greater attention. The cost of long-term care in a formal facility far exceeds those incurred by patients cared for at home on a permanent basis. Some policy makers are now favoring the provision of subsidies for persons who stay home to care for loved ones, arguing that this would save more money than it would cost, in keeping more patients out of expensive long-term care facilities (Johnson and Lo Sasso, 2000).

At first glance this would seem like a cure for everyone's dilemma. Money would be saved in Long-term Care costs; employees could replace income and lost benefits due to having to lose time at work.

However, opponents to this idea point out that the solution may not be as easy as it seems. No studies have been conducted to determine if there are adequate workers to care for the number of elderly. It has also not been shown if the subsidies provide will be adequate to maintain and decent lifestyle. It would be unlikely that a former high salary earner would wish to give that up for minimum wage that barely meets basic subsistence needs. This plan appears to provide solutions, but without further study, it may prove to cause more burden than it resolves.

The Merck Manual of Geriatrics states that geriatric social work is the fastest growing segment of social work, with nearly 49,000 worker nation wide (Berkman, 2000). These social workers provide help with cognitive, behavioral, and emotional issues in elderly patients. They also provide help for caregivers in coping with the stress that caregiving causes. They can help to provide a coordinated plan for the patient an their caregiver (Berkman, 2000). The note the caregivers support system, cultural and ethnic background, and spiritual values. They take these into consideration and help to provide individualized services appropriate to the circumstance. They address the psychological and social issues of long-term care, an area which until recently was entirely overlooked.

It has been found that when a social worker is involved in the long-term care plan, a patient often has shorter hospital stays, and caregivers can gain many benefits including better health for themselves due to lowered stress (Berkman, 2000). The addition of a social worker to the overall care plan of a patient may help relative to care for them at home, thus reducing overall long-term health care costs for the government. Families who care for their loved ones at home need a support system and providing this support system will mean less stress and the ability to keep the proved one at home longer. This system allows the social worker to provide assistance tailored to the individual needs of the family.

Craig Hospital (2003) has conducted several studies on the effects of caring for a sick, disabled, elderly person on a long-term basis. The Craig Hospital reports that caregivers experience many health problems as a result of stress including health problems sleep disorders, and other affects of stress. According to these studies, caregivers who had cared for a quadriplegic for and average of 7 1/2 years had a 75% higher stress level than the average population. Stress appeared as burnout, physical and emotional exhaustion, which manifested in low self-esteem, a negative attitude, a loss of concern for others, and a loss of focus on their own lives (Craig Hospital, 2003).

The Effects on the Caregiver

The Craig Hospital found that stress in caregivers had four major causes. The first cause was a loss of personal time and space. Caring for a loved one who is disabled from any cause does not involve any holidays. The person is always sick and always needs care. The nurse in s facility goes home after their shift. The person caring for someone at home cannot just leave and go home. Many times the caregiver must ignore their own needs to put the needs of others first, especially if they have a family of their own as well. When a new challenge occurs, the time comes out of free time, not caregiving time.

The second cause of stress identified by Craig Hospital was a feeling of social isolation. This is in many times tied to the first cause of stress. Social time is free time and this is the area that suffers the most in long-term care. Many adults who care for loved ones do not get time when they are with other adults who provide stress relief and entertainment.

The relationship between the person being care for and the caregiver often suffer. Relationships between other family members such as a spouse, other than the one being cared for can suffer. Sometimes the spouse or even children can feel ignored due to the amount of time required to care for the patient. Personality changes often occur in the patients, caregivers or other family members and these changes can add stress to the situation.

Caregivers are in a constant state of worry about the patient's condition. They worry about their own health and the health of other s around them. They worry that someone else will not do as good a job as them in caring for their loved one. According to the Craig Hospital these are the key issues that need to be addressed in order to care for the caregiver. Support groups social workers and respite care are several solutions that may help to reduce stress on the caregiver. Counseling can also help to alleviate some of these issues.

There are many significant differences between caring for someone at home and working in a facility. At the facility there are a large number of people who can step in and take over when the work gets too hectic or special situations arise. The home caregiver is often alone; having to deal with whatever comes up and a potentially increasing workload as the patient grows more unable to care for themselves. They may have one or two people who can step in and take over for a short time, but often the caregiver does not rely on them because they do not want to pass on their burden. Sometimes getting relief, even to take care of one's own needs requires a lot of adjustments and inconveniences on everyone's part. It is often easier to just keep trudging on.